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发表于 2010/4/12 18:58:47
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<P class=MsoNormal style="BACKGROUND: white; MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan; mso-outline-level: 2" align=left><SPAN><FONT size=4><FONT color=blue><STRONG>张镜人_证治经验:_九、肾功能不全分阶段论治<?xml:namespace prefix = o ns = "urn:schemas-microsoft-comfficeffice" /><o:p></o:p></STRONG></FONT></FONT></SPAN></P>
<P class=MsoNormal style="BACKGROUND: white; MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-pagination: widow-orphan" align=left><SPAN><FONT size=4><FONT color=blue><STRONG>2008-11-17 21:51:31 来源: 网络收集 显示次数: 编辑:net 张镜人 > 证治经验: 九、肾功能不全分阶段论治 <o:p></o:p></STRONG></FONT></FONT></SPAN></P>
<P class=MsoNormal style="BACKGROUND: white; MARGIN: 4.8pt 0cm 2.4pt; TEXT-ALIGN: left; mso-pagination: widow-orphan" align=left><SPAN><FONT size=4><FONT color=blue><STRONG>对肾功能不全的治疗原则,应为清化湿热,补益脾肾,标本同治,分阶段论治。<o:p></o:p></STRONG></FONT></FONT></SPAN></P>
<P class=MsoNormal style="BACKGROUND: white; MARGIN: 4.8pt 0cm 2.4pt; TEXT-ALIGN: left; mso-pagination: widow-orphan" align=left><SPAN><FONT color=blue size=4><STRONG>1.当湿热蕴阻、耗伤气阴的阶段,临床可见头晕耳鸣,口干唇燥,咽嗌疼痛,面目浮肿,腰酸脊楚,夜寐欠安,溲少色赤,舌苔薄黄或黄腻,质偏红,</STRONG></FONT><A href="http://know.zyy123.com/zyll/mxi/" target=_blank><SPAN lang=EN-US style="FONT-FAMILY: 宋体; TEXT-DECORATION: none; mso-ascii-font-family: Verdana; mso-hansi-font-family: Verdana; mso-bidi-font-size: 12.0pt; text-underline: none"><SPAN lang=EN-US><FONT color=blue size=4><STRONG>脉象</STRONG></FONT></SPAN></SPAN></A><FONT color=blue size=4><STRONG>濡数或细弦滑,尿检蛋白增多,尚有管型及红细胞,肾功能检查已有中度减退,部分病人可见血压偏高。治则为补脾益肾,化湿清热,方宗“保真汤”化裁。用生黄芪、党参、</STRONG></FONT><A href="http://data.zyy123.com/gj/Atractylodes/" target=_blank><SPAN lang=EN-US style="FONT-FAMILY: 宋体; TEXT-DECORATION: none; mso-ascii-font-family: Verdana; mso-hansi-font-family: Verdana; mso-bidi-font-size: 12.0pt; text-underline: none"><SPAN lang=EN-US><FONT color=blue size=4><STRONG>白术</STRONG></FONT></SPAN></SPAN></A><FONT color=blue size=4><STRONG>、大生地、丹参、赤芍、白芍、石斛、知母、黄柏、川续断等。如脾气偏虚,去生地、石斛,加生晒参;肾阴偏虚,去黄芪、党参,加南沙参、</STRONG></FONT><A href="http://data.zyy123.com/Fruit/Wolfberry/" target=_blank><SPAN lang=EN-US style="FONT-FAMILY: 宋体; TEXT-DECORATION: none; mso-ascii-font-family: Verdana; mso-hansi-font-family: Verdana; mso-bidi-font-size: 12.0pt; text-underline: none"><SPAN lang=EN-US><FONT color=blue size=4><STRONG>枸杞</STRONG></FONT></SPAN></SPAN></A><FONT size=4><FONT color=blue><STRONG>子、二至丸;血尿,选加仙鹤草、贯众炭、乌蔹莓、蒲黄炭、赤石脂等;尿蛋白高,选加米仁根、石苇、大蓟根、蝉衣;出现管型,选加莲须、芡实、扦扦活;血压波动,可酌加平肝潜阳的羚羊角粉,石决明等,或用丹参注射液16-20毫升,加入5%葡萄糖溶液500毫升中静滴,每日1次,以扩张局部血管,祛除瘀滞,改善肾脏有效血循环量与肾缺血状态,这不仅有利于促进肾功能的恢复,且对水肿蛋白尿、高血压等都有一定疗效。后期见出血倾向,血小板粘附试验低于正常,则不采取此法。<o:p></o:p></STRONG></FONT></FONT></SPAN></P>
<DIV style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; BACKGROUND: white; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 2.25pt double; mso-element: para-border-div">
<P class=MsoNormal style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; BACKGROUND: white; PADDING-BOTTOM: 0cm; MARGIN: 4.8pt 0cm 2.4pt; BORDER-LEFT: medium none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-border-bottom-alt: double windowtext 2.25pt; mso-padding-alt: 0cm 0cm 1.0pt 0cm" align=left><SPAN><FONT color=blue size=4><STRONG>2.当正气亏损,邪毒内盛的阶段,肾脏功能严重损害。临床可见面色晦滞,神情萎靡,呕恶厌食,口气秽臭,浮肿,尿少或尿闭;进而出现头痛嗜睡,甚至昏迷,衄血,肢体抽搐等危象。在表现有邪浊内盛,上格下关的氮质血症时,治宜益气养营,化湿清热,和胃泄浊,方宗“</STRONG></FONT><A href="http://data.zyy123.com/gj/Coptis/" target=_blank><SPAN lang=EN-US style="FONT-FAMILY: 宋体; TEXT-DECORATION: none; mso-ascii-font-family: Verdana; mso-hansi-font-family: Verdana; mso-bidi-font-size: 12.0pt; text-underline: none"><SPAN lang=EN-US><FONT color=blue size=4><STRONG>黄连</STRONG></FONT></SPAN></SPAN></A><FONT color=blue size=4><STRONG>温胆汤”加减,常用生晒参、生</STRONG></FONT><A href="http://data.zyy123.com/gj/Atractylodes/" target=_blank><SPAN lang=EN-US style="FONT-FAMILY: 宋体; TEXT-DECORATION: none; mso-ascii-font-family: Verdana; mso-hansi-font-family: Verdana; mso-bidi-font-size: 12.0pt; text-underline: none"><SPAN lang=EN-US><FONT color=blue size=4><STRONG>白术</STRONG></FONT></SPAN></SPAN></A><FONT color=blue size=4><STRONG>、赤芍、白芍、川</STRONG></FONT><A href="http://data.zyy123.com/gj/Coptis/" target=_blank><SPAN lang=EN-US style="FONT-FAMILY: 宋体; TEXT-DECORATION: none; mso-ascii-font-family: Verdana; mso-hansi-font-family: Verdana; mso-bidi-font-size: 12.0pt; text-underline: none"><SPAN lang=EN-US><FONT color=blue size=4><STRONG>黄连</STRONG></FONT></SPAN></SPAN></A><FONT color=blue size=4><STRONG>,半夏、陈皮、竹茹、枳壳、晚蚕砂、黑大豆、土茯苓、六月雪等。此际正气已趋衰惫,而湿浊弥温中宫,又急待宣化,故选择补而不腻,凉而不润的生晒参另煎代茶,寓扶正于祛邪之中。如湿浊较重,苔腻满布,可少加苍术5-9g,助</STRONG></FONT><A href="http://data.zyy123.com/gj/Atractylodes/" target=_blank><SPAN lang=EN-US style="FONT-FAMILY: 宋体; TEXT-DECORATION: none; mso-ascii-font-family: Verdana; mso-hansi-font-family: Verdana; mso-bidi-font-size: 12.0pt; text-underline: none"><SPAN lang=EN-US><FONT color=blue size=4><STRONG>白术</STRONG></FONT></SPAN></SPAN></A><FONT color=blue size=4><STRONG>、</STRONG></FONT><A href="http://data.zyy123.com/gj/Coptis/" target=_blank><SPAN lang=EN-US style="FONT-FAMILY: 宋体; TEXT-DECORATION: none; mso-ascii-font-family: Verdana; mso-hansi-font-family: Verdana; mso-bidi-font-size: 12.0pt; text-underline: none"><SPAN lang=EN-US><FONT color=blue size=4><STRONG>黄连</STRONG></FONT></SPAN></SPAN></A><FONT color=blue size=4><STRONG>化湿清热。</STRONG></FONT><A href="http://data.zyy123.com/gj/Coptis/" target=_blank><SPAN lang=EN-US style="FONT-FAMILY: 宋体; TEXT-DECORATION: none; mso-ascii-font-family: Verdana; mso-hansi-font-family: Verdana; mso-bidi-font-size: 12.0pt; text-underline: none"><SPAN lang=EN-US><FONT color=blue size=4><STRONG>黄连</STRONG></FONT></SPAN></SPAN></A><FONT size=4><FONT color=blue><STRONG>兼能止呕,最为理想。黑大豆利中带补,与晚蚕砂、土茯苓、六月雪都具有降尿素氮的作用。如出现神昏,则仿“菖蒲郁金散”意,酌加干菖蒲、炙远志、广郁金、胆星、竺黄等。与此同时,常配合采用中药生川大黄9g,生牡蛎30g,六月雪30g,徐长卿15-30g,皂荚子9g,浓煎100毫升,保留灌肠,导滞泄浊,对因肾气开合无权,水湿泛滥,高度浮肿的少数患者,亦可暂投五苓散以入肾启阳。温通阳气,一俟肿退尿利,病还其本,仍宜转入健脾益肾。继续耐心守治。<o:p></o:p></STRONG></FONT></FONT></SPAN></P></DIV> |
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